Summary

Essentials of Paramedic Care, 2nd edition, is the first text program to take students beyond the skills necessary to practice as a paramedic and into the underlying principles upon which those practices are based. Correlated to the U.S. Department of Transportation's 1998 National Standard Curriculum for EMT-Paramedic, this text provides the background content and skills coverage required for paramedic education. The text, comprised of five divisions, covers all eight modules of the curriculum. Division 1: Introduction to Advanced Prehospital Care (includes Airway Management) Division 2: Patient Assessment Division 3: Trauma Emergencies Division 4: Medical Emergencies Division 5: Special Considerations/Operations (includes Assessment-Based Management)

Table of Contents

Photo Scans/Procedures

xxxi

Letter to Students

xxxv

Preface

xxxvii

Acknowledgments

xli

About the Authors

li

Welcome to Paramedic Care

liii

DIVISION 1 INTRODUCTION TO ADVANCED PREHOSPITAL CARE

1

(5)

Introduction to Advanced Prehospital Care

2

(4)

Introduction

6

(1)

Part 1: Introduction to Advanced Prehospital Care

6

(2)

Description of the Profession

6

(1)

Paramedic Characteristics

7

(1)

The Paramedic: A True Health Professional

7

(1)

Expanded Scope of Practice

8

(1)

Part 2: EMS Systems

8

(15)

History of EMS

9

(3)

Ancient Times

9

(1)

Eighteenth and Nineteenth Centuries

9

(1)

Twentieth Century

10

(1)

The EMS Agenda for the Future

11

(1)

Today's EMS Systems

12

(11)

Local and State-Level Agencies

12

(1)

Medical Direction

13

(1)

Public Information and Education

14

(1)

Communications

15

(1)

Education and Certification

16

(2)

Patient Transportation

18

(1)

Receiving Facilities

19

(1)

Mutual Aid and Mass-Casualty Preparation

20

(1)

Quality Assurance and Improvement

20

(1)

Research

21

(2)

System Financing

23

(1)

Part 3: Roles and Responsibilities of the Paramedic

23

(8)

Primary Responsibilities

23

(3)

Preparation

23

(1)

Response

24

(1)

Patient Assessment and Management

25

(1)

Appropriate Disposition

25

(1)

Patient Transfer

25

(1)

Documentation

26

(1)

Returning to Service

26

(1)

Additional Responsibilities

26

(1)

Community Involvement

26

(1)

Cost Containment

27

(1)

Citizen Involvement in EMS

27

(1)

Professionalism

27

(4)

Professional Attitudes

27

(1)

Professional Attributes

28

(2)

Continuing Education and Professional Development

30

(1)

Part 4: The Well-Being of the Paramedic

31

(16)

Basic Physical Fitness

31

(3)

Core Elements

31

(1)

Nutrition

32

(1)

Preventing Cancer and Cardiovascular Disease

32

(1)

Habits and Addictions

33

(1)

Back Safety

33

(1)

Personal Protection from Disease

34

(4)

Infectious Diseases

35

(1)

Infection Control Practices

35

(3)

Death and Dying

38

(3)

Loss, Grief, and Mourning

38

(1)

What to Say

39

(2)

When It Is Someone You Know

41

(1)

Stress and Stress Management

41

(4)

Shift Work

42

(1)

Signs of Stress

43

(1)

Common Techniques for Managing Stress

44

(1)

Specific EMS Stresses

44

(1)

Mental Health Services

45

(1)

Disaster Mental Health Services

45

(1)

General Safety Considerations

45

(2)

Interpersonal Relations

45

(1)

Roadway Safety

46

(1)

Part 5: Illness and Injury Prevention

47

(6)

Epidemiology

47

(1)

Prevention Within EMS

48

(2)

Organizational Commitment

48

(1)

EMS Provider Commitment

49

(1)

Scene Safety

49

(1)

Prevention in the Community

50

(3)

Areas of Need

50

(1)

Implementation of Prevention Strategies

51

(2)

Part 6: Ethics in Advanced Prehospital Care

53

(35)

Overview of Ethics

53

(3)

Relationship of Ethics to Law and Religion

53

(1)

Making Ethical Decisions

53

(1)

Codes of Ethics

54

(1)

The Fundamental Questions

54

(1)

Fundamental Principles

54

(1)

Resolving Ethical Conflicts

55

(1)

Ethical Issues in Contemporary Paramedic Practice

56

(8)

Resuscitation Attempts

56

(2)

Confidentiality

58

(1)

Consent

59

(1)

Allocation of Resources

59

(1)

Obligation to Provide Care

60

(1)

Teaching

60

(1)

Professional Relation

60

(1)

Research

61

(3)

Medical/Legal Aspects of Advanced Prehospital Care

64

(20)

Introduction

65

(1)

Legal Duties and Ethical Responsibilities

65

(5)

The Legal System

66

(1)

Anatomy of a Civil Lawsuit

67

(1)

Laws Affecting EMS and the Paramedic

68

(2)

Legal Accountability of the Paramedic

70

(3)

Negligence and Medical Liability

70

(2)

Special Liability Concerns

72

(1)

Paramedic-Patient Relationships

73

(6)

Confidentiality

73

(2)

Consent

75

(3)

Legal Complications Related to Consent

78

(1)

Reasonable Force

78

(1)

Patient Transportation

79

(1)

Resuscitation Issues

79

(2)

Advance Directives

80

(1)

Death in the Field

81

(1)

Crime and Accident Scenes

81

(1)

Documentation

81

(3)

Anatomy and Physiology

84

(4)

Introduction

87

(1)

Part 1: The Cell and the Cellular Environment

88

(17)

The Normal Cell

88

(6)

Cell Structure

88

(2)

Cell Function

90

(1)

Tissues

90

(1)

Organs, Organ Systems, and the Organism

91

(1)

System Integration

92

(2)

The Cellular Environment: Fluids and Electrolytes

94

(7)

Water

94

(4)

Electrolytes

98

(1)

Osmosis and Diffusion

99

(2)

Acid-Base Balance

101

(4)

The pH Scale

101

(1)

Bodily Regulation of Acid--Base Balance

102

(3)

Part 2: Body Systems

105

(136)

The Integumentary System

105

(2)

The Skin

105

(1)

The Hair

106

(1)

The Nails

107

(1)

The Blood

107

(10)

Components of Blood

108

(6)

Hemostasis

114

(3)

The Musculoskeletal System

117

(21)

Skeletal Tissue and Structure

117

(3)

Skeletal Organization

120

(12)

Bone Aging

132

(2)

Muscular Tissue and Structure

134

(4)

The Head, Face, and Neck

138

(13)

The Head

138

(5)

The Face

143

(6)

The Neck

149

(2)

The Spine and Thorax

151

(9)

The Spine

151

(4)

The Thorax

155

(5)

The Nervous System

160

(17)

Fundamental Unit: The Neuron

160

(2)

The Central Nervous System

162

(9)

The Peripheral Nervous System

171

(6)

The Endocrine System

177

(11)

Hypothalamus

179

(1)

Pituitary Gland

180

(4)

Thyroid Gland

184

(1)

Parathyroid Glands

184

(1)

Thymus Gland

185

(1)

Pancreas

185

(1)

Adrenal Glands

186

(1)

Gonads

187

(1)

Pineal Gland

187

(1)

Other Organs with Endocrine Activity

187

(1)

The Cardiovascular System

188

(17)

Anatomy of the Heart

188

(4)

Cardiac Physiology

192

(6)

Anatomy of the Peripheral Circulation

198

(2)

The Physiology of Perfusion

200

(5)

The Respiratory System

205

(12)

Upper Airway Anatomy

205

(3)

Lower Airway Anatomy

208

(2)

The Pediatric Airway

210

(1)

Physiology of the Respiratory System

210

(7)

The Abdomen

217

(3)

Abdominal Vasculature

218

(1)

The Peritoneum

219

(1)

The Digestive System

220

(3)

The Digestive Tract

220

(2)

Accessory Organs of Digestion

222

(1)

The Spleen

223

(1)

The Urinary System

223

(5)

The Kidneys

224

(4)

The Ureters

228

(1)

The Urinary Bladder

228

(1)

The Urethra

228

(1)

The Reproductive System

228

(11)

The Female Reproductive System

228

(6)

The Male Reproductive System

234

(5)

General Principles of Pathophysiology

239

(2)

Introduction

240

(1)

Part 1: How Normal Body Processes Are Altered by Disease and Injury

241

(27)

Pathophysiology

241

(1)

How Cells Respond to Change and Injury

241

(5)

Cellular Adaptation

241

(2)

Cellular Injury

243

(3)

Cellular Death: Apoptosis and Necrosis

246

(1)

Fluids and Fluid Imbalances

246

(4)

Water

246

(1)

Edema

247

(1)

Intravenous Therapy

247

(3)

Acid--Base Derangements

250

(2)

Acidosis and Alkalosis

250

(2)

Genetic and Other Causes of Disease

252

(5)

Genetics, Environment, Lifestyle, Age, and Gender

252

(2)

Family History and Associated Risk Factors

254

(3)

Hypoperfusion

257

(11)

The Pathophysiology of Hypoperfusion

257

(4)

Types of Shock

261

(4)

Multiple Organ Dysfunction Syndrome

265

(3)

Part 2: The Body's Defenses against Disease and Injury

268

(41)

Self-Defense Mechanisms

268

(3)

Infectious Agents

268

(2)

Three Lines of Defense

270

(1)

The Immune Response

271

(2)

How the Immune Response Works: An Overview

271

(1)

Characteristics of the Immune Response and Immunity

271

(1)

Induction of the Immune Response

272

(1)

Inflammation

273

(6)

Inflammation Contrasted to the Immune Response

273

(1)

How Inflammation Works: An Overview

274

(1)

Acute Inflammatory Response

274

(1)

Mast Cells

274

(3)

Systemic Responses of Acute Inflammation

277

(1)

Chronic Inflammatory Responses

277

(1)

Local Inflammatory Responses

278

(1)

Resolution and Repair

278

(1)

Variances in Immunity and Inflammation

279

(3)

Hypersensitivity

279

(1)

Deficiencies in Immunity and Inflammation

280

(2)

Stress and Disease

282

(9)

Concepts of Stress

282

(2)

Stress Responses

284

(3)

Stress, Coping, and Illness Interrelationships

287

(4)

Life-Span Development

291

(16)

Introduction

292

(1)

Infancy

292

(4)

Physiological Development

292

(3)

Psychosocial Development

295

(1)

Toddler and Preschool Age

296

(2)

Physiological Development

296

(1)

Psychosocial Development

297

(1)

School Age

298

(1)

Physiological Development

298

(1)

Psychosocial Development

299

(1)

Adolescence

299

(1)

Physiological Development

299

(1)

Psychosocial Development

300

(1)

Early Adulthood

300

(1)

Middle Adulthood

301

(1)

Late Adulthood

301

(6)

Physiological Development

301

(2)

Psychosocial Development

303

(4)

General Principles of Pharmacology

307

(2)

Introduction

309

(1)

Part 1: Basic Pharmacology

309

(17)

General Aspects

309

(2)

Names

309

(1)

Sources

310

(1)

Reference Materials

310

(1)

Components of a Drug Profile

311

(1)

Legal Aspects

311

(2)

Federal

311

(1)

State

312

(1)

Local

313

(1)

Standards

313

(1)

Patient Care: The Safe and Effective Administration of Medications

313

(3)

Six Rights of Medication Administration

313

(1)

Special Considerations

314

(2)

Pharmacology

316

(10)

Pharmacokinetics

317

(5)

Pharmacodynamics

322

(4)

Part 2: Drug Classifications

326

(49)

Classifying Drugs

327

(1)

Drugs Used to Affect the Nervous System

327

(16)

Central Nervous System Medications

327

(9)

Autonomic Nervous System Medications

336

(7)

Drugs Used to Affect the Cardiovascular System

343

(10)

Classes of Cardiovascular Drugs

343

(10)

Drugs Used to Affect the Respiratory System

353

(3)

Antiasthmatic Medications

353

(2)

Drugs Used for Rhinitis and Cough

355

(1)

Drugs Used to Affect the Gastrointestinal System

356

(3)

Drugs Used to Treat Peptic Ulcer Disease

356

(2)

Drugs Used to Treat Constipation

358

(1)

Drugs Used to Treat Diarrhea

358

(1)

Drugs Used to Treat Emesis

358

(1)

Drugs Used to Aid Digestion

359

(1)

Drugs Used to Affect the Eyes

359

(1)

Drugs Used to Affect the Ears

360

(1)

Drugs Used to Affect the Endocrine System

360

(6)

Drugs Affecting the Pituitary Gland

360

(1)

Drugs Affecting the Parathyroid and Thyroid Glands

360

(1)

Drugs Affecting the Adrenal Cortex

361

(1)

Drugs Affecting the Pancreas

361

(3)

Drugs Affecting the Female Reproductive System

364

(1)

Drugs Affecting the Male Reproductive System

365

(1)

Drugs Affecting Sexual Behavior

365

(1)

Drugs Used to Treat Cancer

366

(1)

Drugs Used to Treat Infectious Diseases and Inflammation

366

(2)

Drugs Used to Affect the Skin

368

(1)

Drugs Used to Supplement the Diet

368

(2)

Vitamins and Minerals

369

(1)

Fluids and Electrolytes

369

(1)

Drugs Used to Treat Poisoning and Overdoses

370

(3)

Intravenous Access and Medication Administration

373

(2)

Introduction

375

(1)

Part 1: Principles and Routes of Medication Administration

375

(30)

General Principles

375

(3)

Medical Direction

376

(1)

Body Substance Isolation

376

(1)

Medical Asepsis

376

(1)

Disposal of Contaminated Equipment and Sharps

377

(1)

Medication Administration and Documentation

378

(1)

Percutaneous Drug Administration

378

(3)

Transdermal Administration

378

(1)

Mucous Membranes

378

(3)

Pulmonary Drug Administration

381

(4)

Nebulizer

381

(1)

Metered-Dose Inhaler

382

(2)

Endotracheal Tube

384

(1)

Enteral Drug Administration

385

(5)

Oral Administration

386

(1)

Gastric Tube Administration

387

(2)

Rectal Administration

389

(1)

Parenteral Drug Administration

390

(15)

Syringes and Needles

390

(1)

Medication Packaging

391

(6)

Parenteral Routes

397

(8)

Part 2: Intravenous Access, Blood Sampling, and Intraosseous Infusion

405

(37)

Intravenous Access

405

(30)

Types of Intravenous Access

406

(1)

Equipment and Supplies for Venous Access

407

(7)

Intravenous Access in the Hand, Arm, and Leg

414

(2)

Intravenous Access in the External Jugular Vein

416

(2)

Intravenous Access with a Measured Volume Administration Set

418

(1)

Intravenous Access with Blood Tubing

418

(2)

Factors Affecting Intravenous Flow Rates

420

(1)

Complications of Peripheral Intravenous Access

421

(1)

Changing an IV Bag or Bottle

422

(1)

Intravenous Drug Administration

423

(8)

Venous Blood Sampling

431

(3)

Removing a Peripheral IV

434

(1)

Intraosseous Infusion

435

(7)

Access Site

435

(1)

Equipment for Intraosseous Access

435

(3)

Placing an Intraosseous Infusion

438

(3)

Intraosseous Access Complications and Precautions

441

(1)

Contraindications to Intraosseous Placement

442

(1)

Part 3: Medical Mathematics

442

(103)

Metric System

442

(2)

Conversion between Prefixes

442

(1)

Household and Apothecary Systems of Measure

443

(1)

Weight Conversion

443

(1)

Temperature

444

(1)

Units

444

(1)

Medical Calculations

444

(10)

Desired Dose

445

(1)

Dosage and Volume on Hand

445

(1)

Calculating Dosages for Oral Medications

445

(1)

Converting Prefixes

446

(1)

Calculating Dosages for Parenteral Medications

446

(1)

Calculating Weight-Dependent Dosages

447

(1)

Calculating Infusion Rates

447

(7)

Airway Management and Ventilation

454

(78)

Introduction

456

(1)

Respiratory Problems

456

(2)

Airway Obstruction

456

(2)

Inadequate Ventilation

458

(1)

Respiratory System Assessment

458

(11)

Initial Assessment

458

(1)

Focused History and Physical Examination

459

(3)

Noninvasive Respiratory Monitoring

462

(7)

Basic Airway Management

469

(5)

Manual Airway Maneuvers

469

(2)

Basic Mechanical Airways

471

(3)

Advanced Airway Management

474

(46)

Endotracheal Intubation

475

(26)

Nasotracheal Intubation

501

(3)

Field Extubation

504

(1)

Esophageal Tracheal CombiTube

504

(3)

Pharyngo-Tracheal Lumen Airway

507

(1)

Laryngeal Mask Airway

508

(3)

Esophageal Gastric Tube Airway and Esophageal Obturator Airway

511

(1)

Foreign Body Removal under Direct Laryngoscopy

511

(1)

Surgical Airways

512

(8)

Managing Patients with Stoma Sites

520

(1)

Suctioning

521

(1)

Suctioning Equipment

521

(1)

Suctioning Techniques

522

(1)

Gastric Distention and Decompression

522

(1)

Oxygenation

523

(2)

Oxygen Supply and Regulation

523

(1)

Oxygen Delivery Devices

524

(1)

Ventilation

525

(7)

Mouth-to-Mouth/Mouth-to-Nose Ventilation

525

(1)

Mouth-to-Mask Ventilation

525

(1)

Bag-Valve Devices

526

(1)

Demand Valve Device

527

(1)

Automatic Transport Ventilator

528

(4)

Therapeutic Communications

532

(13)

Introduction

533

(1)

Basic Elements of Communication

533

(2)

Trust and Rapport

533

(1)

Professional Behaviors

534

(1)

Communication Techniques

535

(10)

General Guidelines

535

(2)

Interview Techniques

537

(3)

Patients with Special Needs

540

(3)

Transferring Patient Care

543

(2)

DIVISION 2 PATIENT ASSESSMENT

545

(214)

History Taking

546

(18)

Introduction

547

(1)

Establishing Patient Rapport

547

(3)

Setting the Stage

547

(1)

Language and Communication

548

(1)

Taking a History on Sensitive Topics

549

(1)

The Comprehensive Patient History

550

(8)

Preliminary Data

550

(1)

The Chief Complaint

551

(1)

The Present Illness

551

(2)

The Past History

553

(1)

Current Health Status

554

(2)

Review of Systems

556

(2)

Special Challenges

558

(6)

Silence

558

(1)

Overly Talkative Patients

559

(1)

Patients with Multiple Symptoms

559

(1)

Anxious Patients

559

(1)

Patients Needing Reassurance

559

(1)

Anger and Hostility

559

(1)

Intoxication

560

(1)

Crying

560

(1)

Depression

560

(1)

Sexually Attractive or Seductive Patients

560

(1)

Confusing Behaviors or Histories

560

(1)

Limited Intelligence

561

(1)

Language Barriers

561

(1)

Hearing Problems

561

(1)

Blindness

561

(1)

Talking with Families or Friends

561

(3)

Physical Exam Techniques

564

(87)

Introduction to Physical Examination

565

(1)

Approach and Overview

565

(11)

Examination Techniques

566

(7)

Equipment

573

(2)

The General Approach

575

(1)

Overview of a Comprehensive Examination

576

(9)

The General Survey

576

(9)

Anatomical Regions

585

(57)

The Skin

585

(3)

The Hair

588

(2)

The Nails

590

(1)

The Head

590

(1)

The Eyes

590

(6)

The Ears

596

(4)

The Nose

600

(1)

The Mouth

600

(3)

The Neck

603

(2)

The Chest and Lungs

605

(4)

The Cardiovascular System

609

(3)

The Abdomen

612

(3)

The Female Genitalia

615

(1)

The Male Genitalia

615

(1)

The Anus

615

(1)

The Musculoskeletal System

616

(9)

The Peripheral Vascular System

625

(4)

The Nervous System

629

(13)

Physical Examination of Infants and Children

642

(5)

Building Patient and Family Rapport

642

(1)

Anatomy and the Physical Exam

643

(4)

Recording Examination Findings

647

(4)

Patient Assessment in the Field

651

(53)

Introduction

653

(1)

Scene Size-Up

654

(9)

Body Substance Isolation

655

(1)

Scene Safety

656

(5)

Location of All Patients

661

(1)

Mechanism of Injury

662

(1)

Nature of the Illness

663

(1)

The Initial Assessment

663

(10)

Forming a General Impression

664

(1)

Mental Status

665

(1)

Airway Assessment

666

(1)

Breathing Assessment

667

(1)

Circulation Assessment

668

(1)

Priority Determination

669

(4)

The Focused History and Physical Exam

673

(19)

The Major Trauma Patient

673

(9)

The Isolated-Injury Trauma Patient

682

(1)

The Responsive Medical Patient

683

(7)

The Unresponsive Medical Patient

690

(2)

The Detailed Physical Exam

692

(6)

Components of the Comprehensive Exam

692

(6)

Vital Signs

698

(1)

Recording Exam Findings

698

(1)

Ongoing Assessment

698

(6)

Mental Status

698

(1)

Airway Patency

699

(1)

Breathing Rate and Quality

699

(1)

Pulse Rate and Quality

699

(1)

Skin Condition

699

(1)

Transport Priorities

699

(2)

Vital Signs

701

(1)

Focused Assessment

701

(1)

Effects of Interventions

701

(1)

Management Plans

701

(3)

Clinical Decision Making

704

(12)

Introduction

705

(1)

Clinical Judgment

705

(1)

Paramedic Practice

705

(3)

Patient Acuity

706

(1)

Protocols and Algorithms

706

(2)

Critical Thinking Skills

708

(2)

Fundamental Knowledge and Abilities

708

(1)

Useful Thinking Styles

709

(1)

Thinking Under Pressure

710

(1)

Mental Checklist

711

(1)

The Critical Decision Process

711

(5)

Form a Concept

712

(1)

Interpret the Data

712

(1)

Apply the Principles

712

(1)

Evaluate the Results

713

(1)

Reflect on the Incident

713

(1)

Putting It All Together

713

(3)

Communications

716

(19)

Introduction

717

(1)

Verbal Communication

717

(1)

Written Communication

717

(3)

Terminology

719

(1)

The EMS Response

720

(6)

Response Sequence

720

(6)

Communication Technology

726

(4)

Radio Communication

726

(2)

Alternative Technologies

728

(1)

New Technology

729

(1)

Reporting Procedures

730

(2)

Standard Format

730

(1)

General Radio Procedures

731

(1)

Model Verbal Reports

732

(1)

Regulation

732

(3)

Documentation

735

(24)

Introduction

736

(1)

Uses for Documentation

736

(2)

Medical

736

(1)

Administrative

737

(1)

Research

737

(1)

Legal

737

(1)

General Considerations

738

(7)

Medical Terminology

738

(1)

Abbreviations and Acronyms

738

(5)

Times

743

(1)

Communications

744

(1)

Pertinent Negatives

744

(1)

Oral Statements

744

(1)

Additional Resources

744

(1)

Elements of Good Documentation

745

(3)

Completeness and Accuracy

745

(1)

Legibility

745

(2)

Timeliness

747

(1)

Absence of Alterations

747

(1)

Professionalism

747

(1)

Narrative Writing

748

(5)

Narrative Sections

748

(2)

General Formats

750

(3)

Special Considerations

753

(2)

Patient Refusals

753

(2)

Services Not Needed

755

(1)

Multiple-Casualty Incidents

755

(1)

Consequences of Inappropriate Documentation

755

(1)

Closing

756

(3)

DIVISION 3 TRAUMA EMERGENCIES

759

(320)

Trauma and Trauma Systems

760

(10)

Introduction

761

(1)

Trauma

761

(1)

The Trauma Care System

762

(1)

Trauma Center Designation

762

(2)

Specialty Centers

764

(1)

Your Role as an EMT-Paramedic

764

(6)

Mechanism of Injury Analysis

765

(1)

Index of Suspicion

765

(1)

The Golden Hour

765

(1)

The Decision to Transport

766

(1)

Injury Prevention

766

(1)

Data and the Trauma Registry

767

(1)

Quality Improvement

767

(3)

Blunt Trauma

770

(32)

Introduction

771

(1)

Kinetics of Blunt Trauma

771

(3)

Inertia

771

(1)

Conservation of Energy

772

(1)

Kinetic Energy

772

(1)

Force

773

(1)

Blunt Trauma

774

(28)

Automobile Collisions

774

(13)

Motorcycle Collisions

787

(1)

Pedestrian Collisions

788

(1)

Recreational Vehicle Collisions

788

(2)

Blast Injuries

790

(6)

Other Types of Blunt Trauma

796

(6)

Penetrating Trauma

802

(19)

Introduction

803

(1)

Physics of Penetrating Trauma

803

(8)

Ballistics

804

(2)

Specific Weapon Characteristics

806

(3)

Damage Pathway

809

(2)

Low-Velocity Wounds

811

(1)

Specific Tissue/Organ Injuries

811

(5)

Connective Tissue

811

(1)

Organs

812

(1)

Lungs

812

(1)

Bone

813

(1)

General Body Regions

813

(3)

Special Concerns with Penetrating Trauma

816

(5)

Scene Size-Up

816

(1)

Penetrating Wound Assessment

817

(1)

Penetrating Wound Care

817

(4)

Hemorrhage and Shock

821

(31)

Introduction

822

(1)

Hemorrhage

822

(15)

Clotting

823

(2)

Factors Affecting the Clotting Process

825

(1)

Hemorrhage Control

825

(4)

Stages of Hemorrhage

829

(2)

Hemorrhage Assessment

831

(3)

Hemorrhage Management

834

(3)

Shock

837

(15)

The Body's Response to Blood Loss

838

(1)

Stages of Shock

839

(2)

Shock Assessment

841

(2)

Shock Management

843

(9)

Soft-Tissue Trauma

852

(39)

Introduction

854

(1)

Epidemiology

854

(1)

Pathophysiology of Soft-Tissue Injury

854

(15)

Closed Wounds

855

(2)

Open Wounds

857

(4)

Hemorrhage

861

(1)

Wound Healing

861

(3)

Infection

864

(2)

Other Wound Complications

866

(1)

Crush Injury

867

(1)

Injection Injury

868

(1)

Dressing and Bandage Materials

869

(2)

Types of Dressings and Bandages

869

(2)

Assessment of Soft-Tissue Injuries

871

(4)

Scene Size-up

871

(1)

Initial Assessment

872

(1)

Focused History and Physical Exam

872

(2)

Detailed Physical Exam

874

(1)

Assessment Techniques

874

(1)

Ongoing Assessment

875

(1)

Management of Soft-Tissue Injury

875

(16)

Objectives of Wound Dressing and Bandaging

875

(4)

Anatomical Considerations for Bandaging

879

(2)

Complications of Bandaging

881

(1)

Care of Specific Wounds

882

(4)

Special Anatomical Sites

886

(2)

Wounds Requiring Transport

888

(1)

Soft-Tissue Treatment and Refer/Release

888

(3)

Burns

891

(33)

Introduction

892

(1)

Pathophysiology of Burns

892

(14)

Types of Burns

892

(10)

Depth of Burn

902

(1)

Body Surface Area

903

(1)

Systemic Complications

904

(2)

Assessment of Thermal Burns

906

(6)

Scene Size-up

906

(2)

Initial Assessment

908

(1)

Focused and Rapid Trauma Assessment

909

(3)

Ongoing Assessment

912

(1)

Management of Thermal Burns

912

(3)

Local and Minor Burns

912

(1)

Moderate to Severe Burns

913

(1)

Inhalation Injury

914

(1)

Assessment and Management of Electrical, Chemical, and Radiation Burns